Background: Although homebound older adults are among the highest users of hospital services, the existing health and social services that are provided to them in the community are limited and fragmented. This study attempts to bring this group of older adults to providers’ attention by designing a health-social-oriented self-care mobile Health (mHealth) program and subjecting it to empirical testing. The aim of this study is to shift the current reactive, cure-oriented approach to a preventive and health-promoting model, empowering homebound older adults to take an active role in their health, be responsive to their care needs, and subsequently improve their holistic health. Methods: This is a pilot randomized controlled trial. The study is supported by 5 community centers with an estimated sample size of 68 subjects. The subjects will be randomly assigned to video-based mHealth or control groups when they (1) are aged 60 or over, (2) go outdoors less than once a week in the current 6 months, (3) live within the service areas, and (4) use a smartphone. Subjects in the video-based mHealth group will receive a 3-month program comprising 2 main interventions: nurse case management supported by a social service team and video messages covering self-care topics, delivered via smartphone. The control group will receive usual care. Data will be collected at 2 time points – pre-intervention (T1) and post-intervention (T2). The primary outcome will be self-efficacy, and secondary outcomes will include health outcomes (activities of daily living, instrumental activities of daily living, and medication adherence), perceived well-being outcomes (quality of life and depression), and health service utilization outcomes (outpatient clinic, emergency room, and hospital admission). Discussion: The current study will add to the knowledge gap in using mHealth supported by a health-social team to enhance quality of life and self-care and meet the needs of these particularly vulnerable older adults.

1.
Xiang
X
,
Chen
J
,
Kim
M
.
Trajectories of homebound status in Medicare beneficiaries aged 65 and older
.
Gerontologist
.
2020
;
60
:
101
11
. .
2.
Kim
CO
,
Jang
SN
.
Home-based primary care for homebound older adults: literature review
.
Ann Geriatr Med Res
.
2018
;
22
(
2
):
62
72
. .
3.
Yu
R
,
Wong
M
,
Chang
B
,
Lai
X
,
Lum
CM
,
Auyeung
TW
,
Trends in activities of daily living disability in a large sample of community-dwelling Chinese older adults in Hong Kong: an age-period-cohort analysis
.
BMJ Open
.
2016
;
6
(
12
):
e013259
. .
4.
Woo
J
,
Yu
R
,
Wong
M
,
Yeung
F
,
Wong
M
,
Lum
C
.
Frailty screening in the community using the FRAIL scale
.
J Am Med Dir Assoc
.
2015
;
16
(
5
):
412
9
. .
5.
Sterling-Fox
C
.
Access to five nonprimary health care services by homebound older adults: an integrative review
.
Home Health Care Manag Pract
.
2019
;
31
(
1
):
55
69
.
6.
Shafir
A
,
Garrigues
SK
,
Schenker
Y
,
Leff
B
,
Neil
J
,
Ritchie
C
.
Homebound patient and caregiver perceptions of quality of care in home-based primary care: a qualitative study
.
J Am Geriatr Soc
.
2016
;
64
:
1622
7
. .
7.
Gray
CS
,
Barnsley
J
,
Gagnon
D
,
Belzile
L
,
Kenealy
T
,
Shaw
J
,
Using information communication technology in models of integrated community-based primary health care: learning from the iCOACH case studies
.
Imp Sci
.
2018
;
13
:
87
.
8.
Lupon
J
,
Gonzalez
B
,
Mas
D
,
Urrutia
A
,
Arenas
M
,
Domingo
M
,
Patient’s self-care improvement with nurse education intervention in Spain assessed by the European heart failure self-care behavior scale
.
Eur J Cardiovasc Nurs
.
2008
;
7
:
16
20
.
9.
Hoogendijk
EO
,
van Hout
HP
,
van der Horst
HE
,
Frijters
DH
,
Dent
E
,
Deeg
DJ
,
Do psychosocial resources modify the effects of frailty on functional decline and mortality?
J Psychosom Res
.
2014
;
77
(
6
):
547
51
. .
10.
Bandura
A
.
Self-efficacy: toward a unifying theory of behavioral change
.
Psychol Rev
.
1977
;
84
(
2
):
191
215
. .
11.
Gharaibeh
B
,
Gajewski
BJ
,
Al-Smadi
A
,
Boyle
DK
.
The relationships among depression, self-care agency, self-efficacy and diabetes self-care management
.
J Res Nurs
.
2016
;
21
(
2
):
110
22
. .
12.
Gellis
ZD
,
Kenaley
B
,
McGinty
J
,
Bardelli
E
,
Davitt
J
,
Ten Have
T
.
Outcomes of a telehealth intervention for homebound older adults with heart or chronic respiratory failure: a randomized controlled trial
.
Gerontologist
.
2012
;
52
(
4
):
541
52
. .
13.
Berg
T
,
Winterton
R
,
Petersen
M
,
Warburton
J
.
“Although we’re isolated, we’re not really isolated”: the value of information and communication technology for older people in rural Australia
.
Australas J Ageing
.
2017
;
36
(
4
):
313
7
.
14.
Yao
NA
,
Ritchie
C
,
Cornwell
T
,
Leff
B
.
Use of home-based medical care and disparities
.
J Am Geriatr Soc
.
2018
;
66
(
9
):
1716
20
. .
15.
World Health Organization
.
mHealth: new horizons for health through mobile technologies: second global survey on eHealth
.
Geneva, Switzerland
:
WHO Global Observatory for eHealth
;
2011
.
16.
Free
C
,
Phillips
G
,
Galli
L
,
Watson
L
,
Felix
L
,
Edwards
P
,
The effectiveness of mobile-health technology-based health behaviour change or disease management interventions for health care consumers: a systematic review
.
PLoS Med
.
2013
;
10
(
1
):
e1001362
. .
17.
Schooley
B
,
San Nicolas-Rocca
T
,
Burkhard
R
.
Patient-provider communications in outpatient clinic settings: a clinic-based evaluation of mobile device and multimedia mediated communications for patient education
.
JMIR MHealth UHealth
.
2015
;
3
(
1
):
e2
. .
18.
Ben-Zeev
D
,
Brian
RM
,
Aschbrenner
KA
,
Jonathan
G
,
Steingard
S
.
Video-based mobile health interventions for people with schizophrenia: bringing the “Pocket therapist” to life
.
Psychiatr Rehabil J
.
2018
;
41
(
1
):
39
45
.
19.
Direito
A
,
Carraça
E
,
Rawstorn
J
,
Whittaker
R
,
Maddison
R
.
mHealth technologies to influence physical activity and sedentary behaviors: behavior change techniques, systematic review and meta-analysis of randomized controlled trials
.
Ann Behav Med
.
2017
;
51
(
2
):
226
39
. .
20.
Spring
B
,
Pellegrini
C
,
McFadden
HG
,
Pfammatter
AF
,
Stump
TK
,
Siddique
J
,
Multicomponent mHealth intervention for large, sustained change in multiple diet and activity risk behaviors: the make better choices 2 randomized controlled trial
.
J Med Internet Res
.
2018
;
20
(
6
):
e10528
.
21.
Dekoekkoek
T
,
Given
B
,
Given
CW
,
Ridenour
K
,
Schueller
M
,
Spoelstra
SL
.
mHealth SMS text messaging interventions and to promote medication adherence: an integrative review
.
J Clin Nurs
.
2015
;
24
(
19–20
):
2722
35
. .
22.
Bell
AM
,
Fonda
SJ
,
Walker
MS
,
Schmidt
V
,
Vigersky
RA
.
Mobile phone-based video messages for diabetes self-care support
.
J Diabetes Sci Technol
.
2012
;
6
(
2
):
310
9
. .
23.
Veroff
DR
,
Sullivan
LA
,
Shoptaw
EJ
,
Venator
B
,
Ochoa-Arvelo
T
,
Baxter
JR
,
Improving self-care for heart failure for seniors: the impact of video and written education and decision aids
.
Popul Health Manag
.
2012
;
15
(
1
):
37
45
. .
24.
Chan
AW
,
Tetzlaff
JM
,
Gøtzsche
PC
,
Altman
DG
,
Mann
H
,
Berlin
JA
,
SPIRIT 2013 explanation and elaboration: guidance for protocols of clinical trials
.
BMJ
.
2013
;
346
:
e7586
. .
25.
Abraham
C
,
Michie
S
.
A taxonomy of behavior change techniques used in interventions
.
Health Psychol
.
2008
;
27
:
379
. .
26.
Martin
KS
.
The Omaha system: a key to practice, documentation, and information management
. 2nd ed.
Omaha, NE
:
Health Connections Press
;
2005
.
27.
Chow
SK
,
Wong
FK
.
A randomized controlled trial of a nurse-led case management programme for hospital-discharged older adults with co-morbidities
.
J Adv Nurs
.
2014
;
70
(
10
):
2257
71
. .
28.
Walsh
JJ
,
da Fonseca
RS
,
Banta
A
.
Watching and participating in exercise videos: a test of the theory of planned behaviour, conscientiousness, and the role of implementation intentions
.
Psychol Health
.
2005
;
20
(
6
):
729
41
. .
29.
van Velsen
L
,
Illario
M
,
Jansen-Kosterink
S
,
Crola
C
,
Di Somma
C
,
Colao
A
,
A community-based, technology-supported health service for detecting and preventing frailty among older adults: a participatory design development process
.
J Aging Res
.
2015
;
2015
:
1
9
. .
30.
Leung
DY
,
Leung
AY
.
Factor structure and gender invariance of the Chinese General Self-Efficacy scale among soon-to-be-aged adults
.
J Adv Nurs
.
2011
;
67
(
6
):
1383
92
. .
31.
Marek
KD
,
Stetzer
F
,
Ryan
PA
,
Bub
LD
,
Adams
SJ
,
Schlidt
A
,
Nurse care coordination and technology effects on health status of frail older adults via enhanced self-management of medication: randomized clinical trial to test efficacy
.
Nurs Res
.
2013
;
62
(
4
):
269
78
. .
32.
Lawton
MP
,
Brody
EM
.
Assessment of older people: self-maintaining and instrumental activities of daily living
.
Gerontologist
.
1969
;
9
:
179
86
. .
33.
Jin
H
,
Kim
Y
,
Rhie
SJ
.
Factors affecting medication adherence in elderly people
.
Patient Prefer Adherence
.
2016
;
10
:
2117
25
. .
34.
Lam
ET
,
Lam
CL
,
Fong
DY
,
Huang
WW
.
Is the SF-12 version 2 health survey a valid and equivalent substitute for the SF-36 version 2 health survey for the Chinese?
J Eval Clin Pract
.
2013
;
19
:
200
8
. .
35.
Chi
I
,
Yip
PS
,
Chiu
HF
,
Chou
KL
,
Chan
KS
,
Kwan
CW
,
Prevalence of depression and its correlates in Hong Kong’s Chinese older adults
.
Am J Geriatr Psychiatry
.
2005
;
13
(
5
):
409
16
. .
36.
Laforest
S
,
Nour
K
,
Gignac
M
,
Gauvin
L
,
Parisien
M
,
Poirier
M-C
.
Short-term effects of a self-management intervention on health status of housebound older adults with arthritis
.
J Appl Gerontol
.
2008
;
27
(
5
):
539
67
. .
37.
McNulty
TC
,
Fisher
AG
.
Comparison of activities of daily living ability of older adults who are homebound and nonhomebound
.
Phys Occup Ther Geriat
.
2013
;
31
(
2
):
89
102
. .
38.
Laforest
S
,
Nour
K
,
Gignac
MA
,
Gauvin
L
,
Parisien
M
.
The role of social reinforcement in the maintenance of short-term effects after a self-management intervention for frail housebound seniors with arthritis
.
Can J Aging
.
2012
;
31
(
2
):
195
207
. .
39.
Cocks
K
,
Torgerson
DJ
.
Sample size calculations for pilot randomized trials: a confidence interval approach
.
J Clin Epidemiol
.
2013
;
66
:
197
201
. .
40.
Whitehead
AL
,
Julious
SA
,
Cooper
CL
,
Campbell
MJ
.
Estimating the sample size for a pilot randomised trial to minimise the overall trial sample size for the external pilot and main trial for a continuous outcome variable
.
Stat Methods Med Res
.
2016
;
25
(
3
):
1057
73
. .
41.
Boutron
I
,
Altman
DG
,
Moher
D
,
Schulz
KF
,
Ravaud
P
.
CONSORT Statement for randomized trials of nonpharmacologic treatments: a 2017 update and a CONSORT extension for nonpharmacologic trial abstracts
.
Ann Intern Med
.
2017
;
167
(
1
):
40
7
. .
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.